Does Cigna Cover Addiction Treatment?

A lot of people assume that insurance companies will not cover treatment for substance use disorder, so they let worries about rehab costs keep them from getting help. However, the reality is that all insurance companies are now legally required to provide appropriate levels of addiction treatment.

Cigna currently has a whole department focused on helping its customers get treatment for substance use disorders. The insurer provides coverage for a wide range of treatments, so it is easy to get the type of care you prefer.

Almost any type of addiction that is medically recognized as a behavioral or mental health problem will be covered by Cigna. This includes disorders caused by an addiction to any of these substances:

  • Alcohol
  • Methamphetamine
  • Cocaine
  • Heroin
  • Prescription opioids
  • Benzodiazepines
  • Prescription stimulants
  • Marijuana

Understanding How Cigna Coverage Works

The exact amount of money Cigna will pay to cover your addiction treatment will depend on what sort of policy you have. Most customers who get their insurance through Cigna will have one of these common insurance types:

  • PPO: Cigna’s PPO plans do not require you to stay within a network of providers that work with the insurer and provide discounts to its patients. You may have to pay more for an out-of-network rehab facility, but Cigna will usually still cover part of it.
  • HMO: With Cigna’s HMO plan, you will pick a primary care physician who will help coordinate all your care. The physician will then provide you a referral for a rehab clinic within Cigna’s network of care. These plans tend to have lower premiums and deductibles.
  • EPO: This plan is less pricey than a PPO while still letting you have a lot of flexibility. You can see specialists without a doctor’s referral, but if you do choose to attend a rehab facility outside of Cigna’s network, you’ll have to cover it yourself.
  • POS: A POS combines the perks of a PPO and HMO. You’ll have a doctor who can refer you to clinics as needed, but you also have the option of seeking addiction treatment outside of Cigna’s network for a discounted cost.
  • Medicare: Cigna offers plans through Medicare as well. These let you see any provider anywhere and do not usually require a referral. Depending on the plan you have, it may also cover any medicine prescribed to treat addiction.

Based on your specific plan, Cigna may recover all the costs after you meet your deductible. However, it is more common for the plans to include a coinsurance or a copay. This is a small fee or a certain percentage of the health care costs that you will pay after Cigna covers the rest. Once you meet your yearly out-of-pocket maximum, however, these small charges will go away and Cigna will cover your care completely.

Does Cigna Require Preauthorization Before Addiction Treatment?

Many health care plans require patients to obtain authorization before they get non-emergency medical care. This can require filling out forms to get approval from the company before it will cover your health care. However, Cigna does not always require patients to get authorization on their plans. While some plans may only require authorization when you’re doing inpatient rehab, others might require authorization for outpatient rehab as well.

Typically, Cigna requires patients to get authorization before having any prescription medication, but the insurer has recently changed its policy. Those seeking a prescription for medication to help with opioid addiction no longer need authorization first. Since Cigna’s authorization policies vary so much depending on what service you need and which plan you have, it is always a good idea to check with the company first. If possible, give the helpline a call and see whether you should get authorization for your treatment or not.

How to Tell If You Qualify for Addiction Treatment

To get authorization from Cigna for addiction treatments, you will need to be diagnosed with a substance use disorder. This might be easier than you think. As addiction care experts start to understand this condition better, they have updated the criteria required to achieve an addiction diagnosis. People no longer have to prove that they have legal problems or severe health challenges due to their addictions. Instead, you simply have to meet at least two of these diagnostic criteria:

  • Your drug use puts you in hazardous situations, like driving drunk or engaging in crime.
  • You neglect responsibilities to use drugs instead.
  • Your personal relationships have been harmed by your drug use.
  • You experience withdrawal symptoms when you quit using the drug.
  • You find the drugs no longer affect you as much as they used to.
  • You have to take more and more of the drug to feel the same effect.
  • You try to quit using the drug but cannot.
  • You spend most of your time thinking about, obtaining, or using the drug.
  • Your drug use is causing physical or mental problems.
  • You’ve given up cherished activities to use the drug.
  • You constantly crave the drug.

What Types of Treatment Does Cigna Actually Cover?

When you have Cigna for your health insurance, there are all sorts of treatment options available. Different types of care fall into different categories, so this can affect what coverage you get and if you need preauthorization.

Medical Detox

Detox is the process of purging all traces of the drug from your system. It typically involves withdrawal because your body has become physically dependent on the drug. You may experience problems like vomiting, diarrhea, depression, intrusive thoughts, hallucination, and irregular heart rates. Stopping the use of certain drugs suddenly can even cause life-threatening seizures and heart problems. In particular, medically supervised detox is important if you’re addicted to alcohol or benzodiazepines.

In many cases, withdrawal is so physically dangerous that Cigna counts it as a type of emergency care that is covered in or out of network. Even in cases where you are not in immediate physical danger, detox and withdrawal are still medical necessities that Cigna always has to cover. This coverage can include the cost of various medications like methadone that are intended to help you safely taper down drug usage and reduce cravings and withdrawal.

Outpatient Rehab Facilities

An outpatient rehab center is a facility you regularly visit for treatment. You can still stay at home to care for children or handle other responsibilities, however, since outpatient rehab is adjusted to meet your schedule. There are all sorts of treatments available through outpatient rehab, including:

  • Cognitive behavioral therapy
  • Private counseling
  • Trauma therapy
  • Group counseling
  • 12-step meetings

Outpatient rehab comes in many forms. Partial hospitalization involves regularly visiting the rehab for health care, and intensive outpatient rehab will involve you being at the rehab for hours at a time, several days a week. These types of rehab can offer a great way of managing intense drug addictions while allowing you to sleep in your own bed each night. There are also milder forms of outpatient rehab, like attending a group class each week, that can help you maintain sobriety even when you are out of the initial stages of rehab.

Inpatient Rehab Facilities

Inpatient rehab has the same types of therapy and counseling available with outpatient rehab. However, it requires that you live in the facility instead of just visiting it. This allows you to fit more treatments into a day. It also ensures that there is always someone on hand to care for you, so you get better support. With an entirely new change of environment, some people find that inpatient rehab helps them focus more on recovering. Residential rehabs have medical professionals on-site, so any medical emergencies can be addressed immediately. Inpatient facilities tend to be recommended for those who have severe or long-lasting addictions.

Due to the higher cost and inclusion of potentially non-essential services like nature hikes or horseback riding, Cigna will be a little more cautious about approving inpatient care. The insurer will still cover it, but only in cases where the patient seems likely to benefit from participating in inpatient instead of outpatient programs. Some common reasons Cigna will authorize inpatient care include:

  • You don’t live close to any outpatient clinics.
  • Your home life makes it difficult to stay sober.
  • You’ve been to outpatient rehab before but relapsed.
  • You have physical or mental health problems that will benefit from constant monitoring.

Will Cigna Keep Your Addiction Treatment Private?

Many people who have health insurance through their employer worry that their work managers will see that they have gone to rehab. Fortunately, this is something you do not need to be worried about if you have Cigna health care. The company does not provide detailed personal information about how often you use its insurance or what sort of services you are using.

Legally speaking, employers do have the right to access the types of high-cost treatments they are paying for. However, there is no identifying information attached to this data. Your employer may get a quarterly or annual spreadsheet letting them know that a certain percentage of their health care budget is going toward addiction treatment, but it will not tell the employer which person is getting the treatment. This allows you to maintain your privacy during this sensitive time.

How to Make Sure Cigna Pays for Your Addiction Treatment

As you can see, Cigna makes sure to cover a wide range of addiction treatment services. To get the full benefits of your Cigna coverage, you just need to understand how your plan works. You can visit the myCigna website to log in to your online account and get a full list of your benefits. This will explain if you need to get authorization, show you the types of facilities you can visit, and tell you if there are any copays or coinsurance costs associated with coverage.

We understand that all of this can feel a little overwhelming when you are in the grip of addiction, but fortunately, there are plenty of ways to get help. You can call Cigna’s customer service line to get in touch with an insurance expert who can explain your plan and tell you what you need to do to get your treatment covered. Addiction support organizations like SAMHSA can also walk you through the steps of finding a rehab center and navigating your insurance. A final option is just talking directly to an addiction treatment center. Many of them have counselors who will meet with you completely free of charge and contact your insurance company to handle the details for you. With the right help, it’s possible to focus on your sobriety without having to think about financial difficulties.

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